The nurse is performing a physical assessment on a newly admitted patient. Select subjective or objective for the findings below.
Pulse 68 bpm
7 x 4 cm scar on the left lower abdomen.
Blood pressure 148/92
History of allergies
Last menstrual period
Shortness of breath
Pain 8/10
Brawny edema in lower extremities.
Temperature 101 SF
Use of medications at home
The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"B"},"G":{"answers":"A"},"H":{"answers":"B"},"I":{"answers":"B"},"J":{"answers":"A"}}
Subjective data are based on what the patient reports. These include personal history and symptoms (e.g., allergies, menstrual period, pain level, and medication use).
Objective data are measurable facts that are observed or measured by the nurse, such as vital signs, physical findings (e.g., scars, edema), and lab results (e.g., temperature, blood pressure).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. This grade indicates trace contraction but no movement. It is not appropriate in this case, as the patient has full range of motion.
B. Grade 2. This grade reflects full range of motion with gravity eliminated. The patient’s range of motion is against gravity, so this is not the correct grade.
C. Grade 3. This grade indicates full range of motion against gravity but without resistance. The patient is able to resist full force, so this is not the correct grade either.
D. Grade 5. This grade indicates normal strength with full range of motion against gravity and full resistance. This best describes the patient's strength, which is normal.
Correct Answer is A
Explanation
A. A positive Romberg test occurs when a person loses balance or sways when standing with their eyes closed, indicating a problem with proprioception or balance.
B. Ataxia refers to a lack of coordination or motor control, but the Romberg sign specifically tests balance and proprioception, which is different from ataxia.
C. Lack of coordination may be part of ataxia or other neurological issues, but the Romberg sign specifically refers to balance issues when eyes are closed.
D. The Homans sign is used to test for deep vein thrombosis (DVT) and is not relevant to the test for balance and proprioception described in the scenario.
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